HX64132196 
RC826  .B67  Dvspeosia 


RECAP 


^c&ab 


3!^ 


Columbia  (initier^itp 

CoQese  of  ^f)^siimnsi  anb  burgeons: 
Hibrarp 


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http://www.archive.org/details/dyspepsiaOObowe 


DYSPEPSIA. 


BY 

SERANUS   BOWEN,   M.  D.,  Harv. 

FELLOW   OF  THE   MASSACHUSETTS   MEDICAL   SOCIETY,   ETC.,   ETC. 


"  There  is  no  case  of  dyspepsia,  unless  it  be  accompanied  by  some  necessarily 
fatal  disease,  but  what  can  be  perfectly  and  permanently  cured.'''' 


LORING,  PUBLISHER, 

Corner  Bromfield  and  Washington  Streets, 
BOSTON. 


Copyright,  1877, 
By  SERANUS   BOWEN- 


THE    RIVERSIDE     PRESS,    CAMBRIDGE: 
PRINTED     BY    H,     O.     HOUGHTON    AND    COMPANY. 


I  HAVE  been  led  by  the  suggestions  made  to 
me  by  a  number  of  my  dyspeptic  patients,  to 
print  the  accompanying  pages,  in  the  hope  that  a 
more  rational  view  of  this  disease  may  be  aided 
thereby. 

Any  one  who  reads  this  with  the  expectation  of 
finding  some  universal  panacea  recommended  for 
the  cure  of  every  case,  will  be  disappointed. 

My  aim  has  been  to  point  out  as  clearly  and 
concisely  as  I  can  what  dyspepsia  is,  why  it  is 
such  a  complicated  disease,  and  what  the  rational 
indications  are  for  its  treatment. 

I  do  not  claim  originality  for  all  my  views,  but 
that  they  are  the  conclusions  that  any  reasonable 
physician  will  come  to,  who  makes  a  special  study 
of  dyspepsia. 

no  East  Thirtieth  Street,  New  York, 
March,  1877. 


DYSPEPSIA. 


\^7'HILE  Dyspepsia  is,  strictly  speaking,  a 
symptom  of  disease,  rather  than  a  disease, 
yet  we  find  it  convenient,  in  writing  of  the  great 
variety  of  forms  in  which  it  is  made  manifest  that 
digestion  is  being  carried  on  slowly,  imperfectly, 
or  painfully,  to  class  them  all  under  this  general 
head,  for  the  symptom  of  this  lack  of  nutrition 
that  is  most  commonly  present  is  dyspepsia^  — 
painful  digestion. 

It  is  a  fatal  error  to  take  it  for  granted  that  all 
forms  of  dyspepsia  are  the  result  of  one  and  the 
same  pathological  condition.  For  that  which  is 
good  treatment  in  one  case,  or  series  of  cases,  is 
infinitely  worse  than  no  treatment  at  all,  in  an- 
other. 

Digestion  has  been  aptly  defined  as  "  the  proc- 
ess by  which  food  is  reduced  to  a  form  in  which 
it  can  be  absorbed  by  the  intestines,  and  taken  up 
by  the  blood-vessels."  Until  this  process  is  com- 
pleted, the  necessary  supply  of  that  of  which  the 


6  D  YSPEPSIA. 

body  is   built  up,  cannot  be   used  for  its  nutri- 
tion. 

It  is  not  to  be  wondered  at  that  a  defect  in  any 
part  of  the  alimentary  canal  may  cause  dyspepsia, 
for  unless  the  required  amount  of  the  constituents 
of  the  body  is  properly  assimilated,  there  is  some- 
thing withheld,  which  will  in  time  surely  lead  to 
disease. 

Disease  should  not  be  thought  of  as  something 
added  to  life,  but  as  something  taken  from  it.  It 
is  not,  as  was  formerly  taught,  something  to  be 
attacked  and  driven  out  of  the  body ;  but  it  is  a 
state  in  which  something  has  already  been  taken 
from  the  body,  and  which  it  should  be  the  aim  of 
the  physician  to  restore,  namely,  —  health. 

Perfect  health  is  that  state  of  the  body  in  which 
all  its  functions  are  performed,  perfectly  and  pain- 
lessly. When  one  varies  from  that  condition,  he 
is  just  so  far  diseased. 

There  is  no  single  function  on  which  all  the 
others  are  so  dependent,  as  that  of  the  proper 
assimilation  of  the  nutriment,  which  goes  to  build 
up  the  various  parts  of  the  body. 

Dyspepsia,  the  most  common  of  all  the  diseases 
that  afflict  civilized  man,  is  unfortunately  apt  to 
be  looked  upon,  both  by  the  physician  and  the 
patient,  as  being  not  worthy  of  much  attention 
in  its  earlier  stages ;  neglected  then,  the  disease 


DYSPEPSIA.  7 

becomes  fixed  —  life  is  one  of  misery,  —  and  the 
patient  is  apt  to  seek  relief,  not  from  professional 
hands,  but  from  the  thousand  and  one  nostrums 
advertised. 

The  only  rational  treatment  for  dyspepsia  is 
that  which  endeavors  by  care  and  skill  to  restore 
the  digestive  organs  to  such  a  condition,  that  the 
processes  which  they  are  called  upon  to  perform, 
instead  of  being  painful,  shall  bring  a  sense  of 
comfort. 

There  is  no  case  of  dyspepsia,  unless  it  be  ac- 
companied by  some  necessarily  fatal  disease,  but 
what  can  be  perfectly  and  permanently  cured  by 
careful  and  judicious  treatment. 

The  popular  idea  both  with  the  public  and  a 
large  number  of  the  medical  profession,  that  this 
can  be  brought  about  by  simply  starving  the 
patient,  is  an  erroneous  one.  One  of  the  best 
writers  on  this  subject  says  :  "  I  do  not  think  that 
we  profit  much  from  those  off-hand  advisers  who 
suppose  they  accomplish  everything  by  forbid- 
ding the  use  of  the  sort  of  food  that  produces  the 
symptoms.  On  the  contrary,  as  I  have  shown  by 
examples  which  every  one  may  cap,  out  of  his 
own  patients,  if  he  will  turn  them  over  in  his 
mind,  an  actual  state  of  disease  may  arise  from 
persistence  in  the  remedy. 

"  A  partial   repose  for  a  time,   and  abstinence 


8  D  YSPEPSIA. 

from  an  unnecessary  excess  in  the  undigested 
dishes,  is  doubtless  wise.  But  that  abstinence 
must  not  be  complete  or  final.  What  the  patient 
wants  when  he  complains  that  he  cannot  eat  so- 
and-so,  is  not  to  have  '  don't '  said  to  him,  —  his 
stomach  has  said  so  already,  —  but  to  be  enabled 
to  eat  it  like  other  people." 

The  temporary  rest  which  is  needed,  may  be 
gained  often  by  a  change  in  the  mode  of  prepar- 
ing the  articles  which  cause  most  inconvenience, 
often  by  the  substitution  of  something  else,  not 
so  agreeable,  perhaps,  or  so  common,  but  which 
will  be  more  easily  assimilated. 

In  the  physiological  cure  of  diseases  it  is  al- 
most impossible  to  exaggerate  the  importance  of 
the  digestive  viscera.  In  every  acute  case,  sur- 
gical or  medical,  the  modification  of  the  result 
produced  by  the  efforts  of  the  physician,  rests 
almost  entirely  on  how  far,  how  wisely,  or  how 
foolishly,  these  organs  are  watched  over ;  whether 
they  are  well  or  ill-treated,  either  by  the  scientific 
guidance  of  the  skilled  physiologist,  or  by  the  em- 
pirical rules  of  the  routine  practitioner ;  according 
to  the  traditions  of  the  nurse,  or  the  instinct  of 
the  patient.  Each  of  these  may  be  in  its  way  a 
useful  guide ;  but  the  first  is  at  least  the  most 
capable  of  improvement  by  labor. 

As  regards  chronic  diseases,  also,  science  ena- 


DYSPEPSIA.  9 

bles  us  to  trace  them,  by  steps  more  or  less  dis- 
tinct, —  many  of  them  not  manifested  in  the  or- 
gans themselves,  but  affecting  the  whole  body,  to 
an  abnormal  state  of  the  digestive  viscera.  It 
needs  but  to  name  gout,  tubercle,  anaemia,  and 
some  of  the  forms  of  Bright's  disease,  to  engage 
our  closest  attention  to  their  causes. 

The  fact  is,  that  indigestion,  intervening  be- 
tween the  blood  and  the  new  matter  with  which 
it  seeks  to  renew  itself,  perverts  incipient  life  at 
its  very  source,  and  thus  perverts  all  its  future 
manifestations.  It  produces  a  great  variety  of 
morbid  phenomena,  as  immediate  or  remote  con- 
sequences, and  affects  more  or  less  all  the  func- 
tions of  the  body. 

Whatever  value  may  attach  to  the  evidence  of 
the  dependence  of  disease  on  the  digestive  or- 
gans, it  is  very  clear  that  we  look  to  them  for 
relief  from  disease. 

Out  of  the  six  or  seven  hundred  forms  of  med- 
icines in  habitual  use,  very  i^-^  indeed  are  not 
occasionally  offered  to  the  stomach  for  accept- 
ance, and  an  overwhelming  majority  of  them  can 
only  be  used  in  this  way.  The  great  advantage 
of  paying  special  attention  to  the  digestive  or- 
gans is  that,  as  a  rule,  they  are  the  most  directly 
curable,  and  that  by  their  means,  distant  parts, 
otherwise  out  of  our  control,  may  be  favorably 
influenced. 


lO  DYSPEPSIA. 

Watch  a  case  of  typhoid  fever,  and  see  what 
immediate  improvement  follows  the  shedding  of 
the  dead  epithelium,  with  which  the  mucous 
membranes  have  been  coated,  a  change  which  is 
announced  by  what  is  called  "  the  cleaning  of  the 
tongue," — but  which  foreshadows  much  more, 
in  fact  the  cleaning  of  the  whole  intestinal  tract. 
See  how  immediately  on  this  the  poisoned  nerv- 
ous system  begins  again  to  renew  its  life,  and 
delirium  ceases,  as  new  nervous  matter  fit  for 
duty  is  generated. 

We  must  remember  that  it  is  of  no  use  to  em- 
ploy the  best  possible  means  of  staying  the  mor- 
bid symptoms,  unless  the  absorbents  assimilate  a 
sufficient  quantity  of  new  material  to  replace  that 
which  is  diseased,  and  to  remove  which  we  are 
bestowing  our  pains. 

Labor  is  wasted  in  clearing  away  a  worn-out 
wall,  if  a  new  structure  does  not  take  its  place. 
'To  that  end  the  only  path  is  to  insure  the  assimi- 
lation of  food.  And  to  insure  the  assimilation  of 
food  the  stomach  and  its  colleagues  must  be  in 
working  order. 

But  even  if  diseases  of  the  alimentary  organs 
had  not  so  much  influence  as  they  possess  on  the 
duration  of  life,  their  extreme  frequency  would 
alone  entitle  them  to  attention.  Unfortunately  it 
has  had  a  contrary  effect;  medical  men  are  apt 


DYSPEPSIA.  II 

to  set  down  what  is  so  common  as  inevitable. 
They  neglect  indigestion  as  unimportant,  forget- 
ful that  though  its  removal  may  not  always 
lengthen  lives,  yet  that  it  would  at  all  events 
treble  their  value  both  to  individuals  and  to  so- 
ciety. 

The  digestive  tract  all  the  more  imperatively 
demands  attention,  because  it  has  not  the  advan- 
tage enjoyed  by  the  respiratory  and  by  the  upper 
part  of  the  urinary  apparatus,  and  other  parts,  of 
being  double.  Man  has  two  lungs,  two  kidneys 
two  hemispheres  to  the  brain,  two  sides  to  his 
body  generally;  but  only  one  stomach,  and  one 
intestinal  canal. 

A  reason  for  great  caution  in  preserving  their 
integrity,  —  there  is  less  to  spare  for  disease  to 
affect.  A  deposit  of  tubercle,  for  instance,  the 
size  of  a  nut,  in  the  pulmonary  tissue,  may  be  nei- 
ther here  nor  there,  may  be  never  known  by  its 
effects.  But  put  it  in  the  peritoneum  or  in 
Peyer's  glands,  and  what  a  disturbance  is  pro- 
duced !  A  man  may  lose  a  leg  or  an  arm,  and 
enjoy  life  very  fairly  afterwards ;  but  let  him  lose 
the  use  of  his  oesophagus  or  his  rectum,  and 
what  can  he  hope  for .? 

This  singleness  helps  to  explain  the  powerful 
influence  which  any  one  of  its  parts  has  not  only 
over  the  whole  tract,  but  over  the  whole  body  and 


12  DYSPEPSIA. 

mind.  No  chain  is  stronger  than  its  weakest 
link,  and  an  interruption  of  the  function  at  one 
point,  is  an  interruption  of  the  whole. 

It  also  has  a  bearing  of  considerable  impor- 
tance on  the  treatment.  It  is  extremely  difficult 
to  obtain  that  rest  which  is  so  essential  in  the 
management  of  disease.  If  you  have  pneumonia 
you  may  give  a  holiday  to  the  smitten  lung  and 
recover  with  the  other;  but  if  you  have  an 
equally  acute  inflammation  of  the  oesophagus  or 
stomach,  the  danger  is  great,  because  they  are 
necessarily  in  constant  use. 

In  indigestion  the  cause  of  the  trouble  may  be 
with  any  one  of  a  great  number  of  organs,  and  the 
particular  organ  which  is  at  first  diseased  may  be 
the  subject  of  several  diseases;  but  the  common 
link  which  connects  them  all  is  a  partial  defect  in 
the  necessary  supply  of  that  of  which  the  body 
is  built  up.  This  explains  why  deranged  diges- 
tion affects  more  or  less  all  the  functions  of  the 
body. 

In  the  management  of  deranged  digestion, 
whether  existing  alone  or  as  a  complication  of 
other  complaints,  it  is  important  to  know  what 
oreans  are  desfenerated,  and  to  some  extent  the 
treatment  must  be  modified  by  such  knowledge. 
Even  in  many  incurable  diseases,  life  is  much 
prolonged,  made  happier  and  more  easy,  by  care- 


DYSPEPSIA.  13 

ful  and  judicious  attention  to  the  digestive  ap- 
paratus. 

In  all  diseases,  but  especially  in  those  of  a 
chronic  character,  the  most  important  function  for 
us  to  pay  attention  to  is  digestion.  The  effect  of 
climate,  for  instance,  in  pulmonary  consumption, 
is  proportioned  with  extreme  accuracy  to  the  de- 
gree in  which  the  absorption  of  food  is  improved 
or  injured  by  it 

Take,  for  example,  anaemia,  a  disease  which  is 
characterized  by  every  sign  of  debility;  the  es- 
sential character  of  the  blood  in  this  disease  is  a 
diminution  in  the  ratio  of  red  corpuscles.  If,  as 
generally  happens,  iron  improves  the  condition 
of  the  alimentary  canal,  so  that  the  stools,  from 
being  scanty,  and  mucous,  consisting  mainly  of 
wind  and  half  digested  food,  become  natural  and 
regular,  then  the  body  is  renewed  by  fresh  nutri- 
ment, and  the  strength  is  rapidly  reinstated ;  but 
if  it  irritates  the  mucous  membrane,  so  as  to 
make  the  evacuations  irregular,  black,  and  slimy, 
the  patient  remains  as  anaemic  as  ever.  Hence 
the  importance  of  suiting  to  the  case  in  hand  the 
particular  form  in  which  the  remedy  shall  be  pre- 
sented. If  ready  solubility,  and  presentation  to 
the  absorbing  surface,  in  such  shape  as  to  get  an 
entrance  of  a  large  quantity  quickly  into  the  sys- 
tem, were  the  only  thing  to  be  considered,  the 


14  DYSPEPSIA. 

question  as  to  which  is  the  best  preparation 
might  be  left  to  the  chemist.  Some  preparations, 
both  soluble  and  insoluble,  are  more  or  less  astrin- 
gent, and  have  various  qualities  acting  on  various 
parts  of  the  alimentary  canal,  which  render  them 
appropriate  or  not  to  individual  cases.  So  that 
not  the  most  elegant,  not  the  most  praised  as  in- 
genious by  the  druggist,  is  the  oftenest  selected 
by  the  judicious  physician,  to  whom  the  cure  of 
the  patient,  not  the  harmony  of  the  prescription, 
is  the  object  in  view. 

And  it  is  not  only  the  general  health  that  is 
benefited  by  attending  to  the  functions  of  the 
stomach,  but  even  organs  as  far  as  possible  re- 
moved from  the  stomach,  physiologically  speak- 
ing. A  patient  who  has  an  enlarged  prostate 
gland,  when  digesting  well,  finds  that  his  urine  is 
quite  transparent,  and  free  from  mucus,  even  when 
microscopically  examined ;  but  if  the  stomach  is 
disturbed  by  any  imprudence  or  accidental  ill- 
ness, there  is  a  copious  formation  of  pus  in  the 
bladder. 

My  object,  thus  far,  has  been  to  lead  you  to  rate 
aright  the  importance  of  the  proper  management 
of  the  digestive  organs  in  disease.  I  mean  dis- 
ease generally,  and  not  that  which  specifically 
afiects    these   organs   alone. 

I  shall  now  endeavor  as  concisely  as  possible  to 


DYSPEPSIA.  15 

give  a  sketch  of  some  of  the  principal  modes  in 
which  the  function  of  digestion  is  deranged,  and 
to  point  out  what  rational  indications  for  treat- 
ment they  afford. 

The  morbid  phenomena  accompanying  these 
errors  of  the  digestive  function  may  be  divided 
according  as  they  occur  during  the  first  stage,  — 
that  is  before  the  ahmentary  mass  has  passed  out 
of  the  stomach;  in  the  second  stage,  —  that  is 
during  its  passage  along  the  small  intestines ;  or 
in  the  third  stage, — after  the  passage  of  the  ileo- 
Ccecal  valve,  which  divides  the  small  from  the 
large  intestines. 

In  the  first  stage,  we  may  notice  as  common 
phenomena  those  generally  known  by  the  follow- 
ing names  :  Heartburn,  Acidity,  Weight,  Tight- 
ness or  Distention,  Oppression,  Wearing  or  Boring 
Pain,  Cramp  or  Spasms,  Eructation,  Vomiting. 

Heartburn  is  a  sense  of  heat  at  the  cardiac 
orifice  of  the  stomach  ;  that  is,  where  the  oesoph- 
agus (or  gullet)  enters  the  stomach.  This  may 
arise  in  three  ways  :  — 

First.  By  over-sensitiveness  of  the  nerves ; 

Second.  By  too  long  exposure  to  the  acids  of 
digestion ; 

Third.  By  too  much  acid  being  formed. 

That  which  arises  from  over-sensitiveness  of 
the  nerves,  is  frequently,  though  not  always,  ac- 


1 6  DYSPEPSIA. 

companied  by  over-sensitiveness  in  other  parts 
of  the  body,  and  is  the  form  of  heartburn  which 
weak,  nervous,  and  hysterical  persons  usually 
suffer  from. 

It  comes  on  almost  immediately  after  eating, 
and  if  vomiting  does  not  occur,  remains  until  the 
acidity  has  been  neutralized  either  by  the  abun- 
dant flow  of  the  alkaline  saliva  down  the  gullet, 
or  by  taking  some  alkali. 

The  worst  of  this  neutralization,  either  natural 
or  artificial,  is  that  a  good  deal  of  albuminous 
food  remains  undigested.  It  is  absolutely  requi- 
site for  the  solution  of  albuminoid  substances, 
by  the  gastric  juice,  that  they  should  be  acid 
while  in  the  stomach ;  and  if  this  natural  acidity 
is  prevented  because  it  happens  to  be  painful  to 
the  over-sensitive  nerves,  the  gastric  juice  cannot 
act.  Thus  digestion  from  being  painful  becomes 
defective  also. 

This  form  of  heartburn  usually  occurs  in  nerv- 
ous, sensitive  persons,  and  may  be  caused  by 
over-anxiety,  watching,  harassing  mental  emo- 
tions, or  any  external  circumstances  which  pro- 
duce over-sensitiveness.  In  the  female  it  is  some- 
times caused  by  tumors  of  the  uterus,  or  by 
pregnancy ;  and  in  the  male  I  have  known  it  to 
be  induced  by  piles,  or  by  constipation. 

It  is  also  not  infrequently  associated  with  head- 
ache, or  some  other  form  of  neuralgia. 


D  YSFEFSIA.  1 7 

The  indications  in  this  form  of  heartburn  are, 
first  to  deaden  the  over-sensibility  of  the  nerves, 
and  then  to  follow  up  this  merely  temporary  re- 
lief with  appropriate  tonics  which  shall  effect  a 
permanent  cure. 

The  form  of  heartburn,  which  is  produced  by 
too  long  exposure  of  the  food  to  the  acids  of  di- 
gestion, never  comes  on  immediately  after  eating, 
—  usually  not  until  from  one  to  three  hours  after 
a  meal.  The  long  continuance  of  this  is  apt  to 
bring  on  the  first  form  after  a  time,  and  it  fre- 
quently brings  on  nervous  headache  and  occasion- 
ally a  decided  intermittent  neuralgia,  aggravated 
by  the  same  causes  and  removable  by  the  same 
remedies  as  that  arising  from  marsh  miasma. 

The  persons  in  whom  it  most  frequently  occurs 
are  active  men  of  business,  literary  laborers,  clerks, 
the  over-thoughtful,  and  the  over-careful. 

That  form  which  is  produced  by  too  much  acid 
being  formed  in  the  stomach,  is  the  only  one  to 
which  the  name  of  "  acidity  "  is  applied  with  pro- 
priety, for  it  is  only  in  this  variety  of  heartburn 
that  there  is  really  an  excess  of  acid. 

The  pain  is  much  less  intense  than  in  the 
other  varieties,  but  the  regurgitations  are  much 
greater;  sometimes  true  vomiting  occurs;  some- 
times only  a  teaspoonful  of  intensely  sour  liquid 
comes  up,  roughening  the  teeth,  and  bringing  the 

3 


1 8  DYSPEPSIA. 

tears  into  the  eyes ;  sometimes  a  gaseous  acid  is 
belched  up  spasmodically ;  sometimes  it  oozes  up 
gradually,  and  its  presence  is  shown  by  the  saliva 
and  breath  being  sour  to  the  taste  and  smell. 

A  permanent  cure  of  this  disease  can  only  be 
brought  about  by  the  use  of  such  remedies  as 
strengthen  the  local  power  of  the  gastric  solvent, 
augment  its  quantity,  and  excite  the  peristaltic 
motions. 

In  this,  as  in  a  great  number  of  the  varieties  of 
dyspepsia,  the  patient  is  tempted  to  take  some- 
thing in  the  form  of  a  cathartic,  which  in  some 
cases,  gives  him  temporary  relief,  but  which  is 
certain  to  leave  him  in  a  worse  condition  than 
that  in  which  he  was  at  first. 

Weight,  Tightness,  Distention,  sometimes  a 
feeling  expressed  as  being  "  blown  out  with  wind," 
while  on  examination  of  the  epigastrium,  the 
stomach  is  found  not  to  be  more  tumid  than  that 
of  a  healthy  person  while  digesting,  —  are  modifi- 
cations of  a  sensation  produced  in  the  nerves  of 
the  stomach  itself. 

Where  this  sensation  exists  alone,  unaccom- 
panied by  soreness,  or  pain  on  pressure,  or  by 
decided  pain  immediately  after  eating,  it  is  com- 
paratively easy  to  judge  of  the  real  meaning  ot 
the  phenomenon. 

Like  all  other  mucous  membranes,  that  of  the 


DYSPEPSIA.  19 

stomach  may  be  affected  acutely  or  chronically. 
The  acute  form  may  be  called  "  gastric  catarrh  ;  " 
the  chronic  form  "  mucous  flux."  Both  are  liable 
to  be  followed  by  vomiting,  which  relieves  tempo- 
rarily the  distress,  and  which  in  the  acute  variety 
constitutes  the  most  ordinary  form  of  "  bilious 
attack,"  so  called  from  the  bile,  which  the  action 
of  the  diaphragm  in  vomiting,  causes  to  regurgi- 
tate along  with  the  contents  of  the  stomach. 

When  not  rejected  by  vomiting,  the  food  which 
has  been  eaten  is  so  enveloped  in  mucus  that  it 
cannot  be  acted  upon  by  the  gastric  juice,  and  is 
passed,  very  little  changed,  into  the  bowels,  where 
it  is  liable  to  ferment,  and  by  its  acidity,  cause 
diarrhoea,  flatulence,  and  sometimes  a  copious  dis- 
charge of  mucus  from  the  bowels.  This  latter 
result  is  more  common  in  acute,  than  in  chronic 
cases,  where  the  motions  are  often  infrequent 
and  irregular,  and  the  faeces  are  unformed  and 
lumpy. 

In  acute  cases  this  excess  of  mucus  is  often 
accompanied  by  very  intense  headache,  but  in 
chronic  it  seldom  goes  beyond  a  feeling  of  stu- 
pidity. Flushing  of  the  face,  and  heat  at  the 
back  of  the  eyes,  are  also  nervous  symptoms  de- 
pendent upon  the  chronic  condition. 

"  Acute  catarrh  of  the  stomach,"  like  all  other 
catarrhs,  is  often  excited  by  external  and  often 
by  epidemic  influences. 


20  DYSPEPSIA. 

"  Mucous  flux  "  is  more  dependent  on  organic 
changes  in  either  the  stomach  itself  or  some 
other  organ.  Tubercles  in  the  lungs,  chronic 
bronchitis,  enlarged  heart,  oftenest  produce  it, 
and  it  is  not  infrequently  associated  with  can- 
cerous, tubercular,  and  inflammatory  affections  of 
the  neighboring  parts. 

When  this  sensation  of  weight,  tig]jtness,  or 
distention  is  accompanied  with  soreness  on  press- 
ure, more  especially  if  the  soreness  exist  when 
the  stomach  is  empty,  or  if  accompanied  by  a 
decided  pain  arising  from  the  indigestion  of  food, 
it  denotes  that  the  secretion  of  mucus  depends 
upon  some  local  inflammation  or  ulceration,  of 
a  chronic  character,  in  the  mucous  membrane. 
When  a  tumor  can  be  felt,  the  probability  is, 
that  it  is  of  a  cancerous  nature.  When  there 
has  been  bloody  vomiting,  it  is  almost  certain 
that  there  is  an  ulcer,  either  cancerous  or  non- 
cancerous. 

The  excessive  secretion  of  mucus  in  the  stom- 
ach, from  whatever  cause  it  may  arise,  is  indicated 
by  the  distention  mentioned  above.  But  the  evil 
rarely  stops  here.  The  gastric  juice  that  is  poured 
out  cannot  penetrate  the  slimy  layer  that  envel- 
opes, as  in  a  bag,  the  food  which  has  been  eaten, 
and  consequently  it  ferments,  and  produces  all  the 
evils  arising  from  chemical  decomposition  in  the 


DYSPEPSIA.  21 

stomach.  Hence  acidity  and  heartburn  arise  as 
heretofore  explained ;  and  hence,  in  some  consti- 
tutions, vomiting,  in  others  a  passage  of  the  fer- 
mentins:  mass  into  the  bowels,  and  diarrhoea. 

It  must  always  be  borne  in  mind  that  mucus  is 
a  substance  that  is  absolutely  indigestible. 

The  indications  for  treatment  derived  from  a 
mucous  condition  of  the  stomach  are  as  follows : 
First,  it  must  be  remembered  that  it  is  not  only 
an  evidence  of  disease,  but  it  is  also  a  cause  of 
further  trouble,  and  therefore  should  be  directly 
restrained  by  astringents. 

Secondly,  the  place  of  the  patient's  own  gastric 
juice,  which  cannot  get  at  the  food,  must  be  sup- 
plied by  artificial  solution  of  the  aliments,  and 
their  decomposition  must  be  prevented. 

Thirdly,  alterative  diet,  and  medicines,  and  local 
counter-irritants,  must  be  used  to  relieve  the  con- 
gested or  degenerated  condition  of  the  organ  at 
fault,  especially  in  those  cases  which  are  compli- 
cated with  pain. 

It  must  be  remembered  that  in  these  cases  pur- 
gatives of  whatever  kind  are  sure  to  do  harm. 

Oppression  is  often  complained  of  at  the  same 
time  with  the  weight,  tightness,  or  distention  of 
the  epigastrium.  But  it  means  something  more, 
and  is  by  no  means  identical.  Indeed,  in  those 
cases  of  mucus   on  the  stomach,  which   relieve 


2  2  DYSPEPSIA. 

themselves  by  vomiting,  or  rapidly  passing  on 
with  the  alimentary  mass,  there  is  no  oppression 
at  all. 

Oppression  indicates  a  general  feeling  of  mor- 
bid lassitude  and  physical  incapacity  throughout 
the  whole  body.  There  is  a  confusion  of  ideas, 
sometimes  an  unnatural  sleep,  sometimes  faintness, 
irregular  nervous  action,  such  as  flushings  of  the 
face,  palpitations  of  the  heart,  fidgets,  twitchings, 
or  cramp. 

As  I  said  before,  these  are  often  the  accompa- 
niments of  gastric  mucous  flux,  but  at  the  same 
time  they  may  often  exist  without  it,  and,  indeed, 
almost  anybody  may  bring  them  on  by  getting 
very  tired  and  then  eating  largely.  If  vomiting 
occurs,  you  see  no  mucus  in  the  egesta,  but  sim- 
ply the  food  last  taken,  unaltered  in  quality  or 
appearance.     Digestion  has  completely  stopped. 

Oppression  shows  an  exhausted  condition  of 
the  muscular  and  nervous  system  of  the  stomach. 
The  causes  are  those  which  usually  exhaust  the 
nervous  energies  without  stimulating  the  powers 
of  life,  such  as  prolonged  and  severe  intellectual 
labor,  annoyance  of  mind,  and  overstrained  atten- 
tion. Temporarily  and  in  persons  previously  dis- 
posed, mere  corporeal  exertion  may  bring  it  on. 
It  is  obvious  that  the  treatment  should  be  to  re- 
store to  the  stomach  its  natural  tone. 


DYSPEPSIA.  23 

Wearing  or  Boring  Pain  is  nearly  always  suffi- 
cient to  arouse  a  suspicion  of  ulceration.  The 
suspicion  is  strengthened  if  weight,  and  tightness 
of  the  epigastrium  be  present,  to  indicate  the  ex- 
cessive secretion  of  mucus  which  usually  accom- 
panies chronic  ulcer ;  and  the  diagnosis  is  further 
confirmed  by  the  occurrence  of  bloody  vomiting. 

It  is  in  these  cases  that  the  failing  organ  re- 
quires to  be  spared  work.  Liquid  food  should 
be  given,  such  as  milk  with  lime  or  soda  water, 
in  small  quantities  and  as  frequently  as  possible. 
The  chief  object  of  the  lime  water  is  to  prevent 
the  milk  from  forming  a  large  curd,  but  it  is  also 
a  sedative  to  the  raw  surface,  just  as  it  is  to  a 
blistered  or  burnt  skin. 

Cramp  or  Spasmodic  Pain  in  the  epigastrium 
appears  to  arise  from  the  pylorus,  where  the  food 
passes  from  the  stomach  to  the  intestines.  It  oc- 
curs chiefly  in  old  persons,  and  does  not  show  any 
organic  disorder  of  the  part.  A  simple  remedy, 
such  as  a  thimbleful  of  brandy  with  two  drops  of 
laudanum,  is  as  efficient  as  anything  that  can  be 
administered. 

Flatulence.  The  intestines  naturally  contain 
a  certain  amount  of  atmospheric  air  and  carbonic 
acid  gas,  and  it  is  only  when  these  gases  are  in 
excess  that  they  are  spoken  of  as  "  flatulence." 

Eructation.    In  health  all  the  air  that  finds  its 


24  DYSPEPSIA. 

way  into  the  stomach  is  readily  absorbed,  and 
many  individuals  never  pass  it  away,  either  up- 
wards or  downwards,  for  months  together;  indeed, 
so  long  as  the  perfect  type  of  health  is  preserved, 
it  may  be  said  to  be  never  excreted. 

After  a  meal,  the  abdomen  of  a  perfectly  healthy 
person  is  somewhat  distended  with  air,  but  it  is 
all  removed  by  absorption  before  the  next. 

In  many  morbid  conditions  this  is  not  done. 
When  the  vitality  is  lowered,  probably  the  func- 
tion most  generally  interfered  with  is  absorption. 
The  air  collects,  is  swelled  by  heat,  and  expelled, 
although  it  may  be  present  in  no  excessive  quan- 
tity. Should  the  oesophagus  be  easily  relaxed, 
there  is  eructation  ;  should  it  be  contracted,  there 
is  intestinal  flatulence. 

So  far,  we  have  spoken  of  the  air  as  being  in- 
creased only  by  heat  and  expansion.  But  in  some 
cases  it  is  further  augmented  by  gases  disengaged 
from  decomposed  food.  Even  alcoholic  fermen- 
tation sometimes  occurs  in  the  stomach,  as  is 
proved  by  instances  of  vomiting  in  which  the 
matters  ejected  are  visibly  undergoing  this  chem- 
ical change. 

In  all  these  cases  the  treatment  should  aim  at 
restoring  the  proper  tone  to  the  stomach. 

Intestinal  Flatulence.  In  a  state  of  health 
the  gases  formed  in  the  intestines  are  reabsorbed 


DYSPEPSIA.  25 

almost  as  soon  as  they  are  formed,  so  that  the 
abdomen  is  puffy  only  for  a  short  time  after 
meals ;  but,  as  explained  before,  lowered  vitality 
promotes  the  collection  of  air  by  arresting  ab- 
sorption. 

Lowered  vitality  also  increases  the  extent  of 
decomposition  by  diminishing  the  flow  of  bile. 
One  of  the  chief  functions  of  the  bile  is  to  act  on 
the  albuminous  matters  contained  in  the  food,  by 
preventing  their  decomposition,  and  preserving 
them  safely,  to  be  exposed  to  the  absorbents  of 
the  intestines. 

Excess  of  gas  in  the  small  intestines  is  the  most 
troublesome  sort  of  wind.  Should  it  escape  up- 
wards through  the  pylorus  into  the  stomach,  it  is 
apt  to  cause  vomiting,  or  sometimes  it  causes  a 
most  nauseous  eructation  of  sulphureted  hydro- 
gen. 

There  seems  to  be  some  difiEculty  about  the 
passage  of  the  air  downwards  through  the  ileo- 
csecal  valve,  which  separates  the  small  from  the 
large  intestines.  Hence,  intestinal  flatus  often 
rolls  about  in  the  abdomen,  causing  the  well- 
known  and  distressing  "  grumblings,"  and  the  ab- 
domen will  sometimes  be  distended  and  painful 
for  several  days  with  it,  without  its  being  expelled 
or  absorbed. 

There  is  often  considerable  pain  on  one  side 
4 


26  DYSPJEVSIA. 

or  the  other,  most  generally  just  below  the  ribs 
on  the  right,  and  then  patients  are  almost  certain 
to  complain  that  their  "liver  is  out  of  order." 
When  there  is  most  pain  in  the  side  there  is  least 
"  grumbling "  of  the  abdomen,  and  it  probably 
arises  from  the  long  continued,  immovable,  dis- 
tention of  one  part  of  the  intestine. 

Flatulence  of  the  intestines  is  troublesome  dur- 
ing the  day,  but  when  it  comes  on  at  night  it 
causes  still  more  inconvenience  by  preventing 
sleep.  In  many  cases  there  is  not  pain  enough 
to  account  for  it,  yet  a  complete  wakefulness  pre- 
vails. It  is  also  to  be  remarked  that  this  sleep- 
lessness is,  in  most  instances,  made  worse  by 
opium. 

Sometimes  the  patient  will  go  to  sleep  easily 
and  naturally  on  first  lying  down,  and  will  then 
wake  up  in  an  hour  or  two,  finding  the  abdomen 
tumid  and  uncomfortable,  and  will  remain  entirely 
without  rest  for  the  remainder  of  the  night ;  or  if 
there  be  a  lapse  into  unconsciousness  for  a  few 
minutes,  the  uneasy  sleep  seems  rather  to  aggra- 
vate than  to  relieve  the  feverish  restlessness,  and 
to  cause  headache. 

The  persons  most  liable  to  this  troublesome 
affection  are  women,  especially  those  of  a  weak 
muscular  fibre,  and  a  tendency  to  form  fat. 

In  cases  of  this  kind  the  treatment  has  to  be 


DYSPEPSIA,  27 

conducted  with  great  care.  Remedies  which  pro- 
mote the  flow  of  bile  are  of  course  indicated,  as 
well  as  those  which  arrest  decomposition ;  and 
above  all,  those  which  restore  the  intestinal  mu- 
cous membranes  to  their  normal  tone. 

Mercury  is  certainly  a  powerful  temporary  re- 
lief, but  it  has  to  be  resorted  to  again  and  again, 
until  its  habitual  use  gives  rise  to  anaemia.  And 
the  patient  should  be  warned  that  any  remedies 
which  are  purgative  will  be  certain  to  produce  a 
bad  effect. 

With  regard  to  diet,  the  patient  should  have  a 
full  allowance  of  lean  meat  and  water ;  should 
avoid  butter  and  fat,  as  well  as  rich  sauces ;  and  if 
alcohol  is  allowed  at  all,  it  should  only  be  in  very 
small  quantity. 

The  most  common  affection  of  the  nervous 
system,  arising  from  imperfect  digestion,  is  Head- 
ache. 

It  occurs  from  a  great  variety  of  causes,  as  has 
already  been  stated,  and  the  only  rational  means 
to  take  for  its  cure  is  to  endeavor  to  remove  the 
morbid  condition  of  the  organs  that  are  affected. 
Without  this  the  headache  can  be  only  tempora- 
rily relieved,  and  of  course  there  will  be  a  fre- 
quent recurrence  of  it.  The  same  thing  may  be 
said  of  the  great  variety  of  other  nervous  symp- 
toms that  arise  from  indigestion. 


28  DYSPEPSIA. 

I  have  hardly  alluded  to  Constipation  as  one 
of  the  results  of  indigestion.  It  is  one  of  the 
most  common  affections,  and  one  that  needs  care 
and  skill  to  cure. 

Patients  who  are  troubled  in  this  way  have  usu- 
ally been  dosed  with  all  sorts  of  purgatives,  from 
blue  pill  down  through  the  whole  list,  not  to 
mention  the  various  patent  medicines,  *'  aperi- 
ents," and  "  bitters." 

The  result  of  all  this  is  that  the  whole  intes- 
tinal tract  is  worn  out,  and  is  not  capable  of 
healthy  action.  And  the  longer  any  chronic  con- 
dition has  remained,  the  more  time  and  patience 
will  be  required  for  its  cure. 

Indigestion  does  not  prevent  Corpulence.  In 
fact,  it  is  probable  that  one  cause  of  that  hyper- 
trophy, is  the  delay  of  the  food,  both  animal  and 
vegetable,  in  the  stomach,  and  the  setting  up,  in 
the  carbonaceous  material,  of  a  fatty  fermentation 
instead  of  digestion. 

This  obesity  of  persons  with  weak  gastric  di- 
gestion is  peculiarly  distressing.  The  defect  in 
muscular  power  prevents  a  sufficient  amount  of 
exercise  to  keep  it  from  increasing,  hence  it  be- 
comes a  daily  growing  inconvenience. 

The  encroachment,  too,  of  the  fatty  upon  the 
other  tissues,  and  the  dilute  spread  of  the  insuffi- 
cient blood,  through  an  unnaturally  large  quan- 


DYSPEPSIA.  29 

tity  of  minute  blood-vessels,  tend  to  produce  de- 
fective nutrition  of  important  parts  ;  and  hence 
we  find,  as  a  consequence  of  corpulence,  dilata- 
tions and  degenerations  of  the  heart,  fatty  depos- 
its on  the  same,  Bright's  disease  of  the  kidneys, 
etc.  The  addition  to  the  body  of  many  pounds, 
in  the  shape  of  fat,  requires  certainly  a  very  large 
addition  of  blood  and  blood-vessels  to  nourish  it, 
and  yet  the  same  heart  has  still  to  undertake  this 
labor. 

The  balance,  then,  between  the  systemic  and 
pulmonary  circulation  must  be  destroyed,  and  the 
lungs  be  unequal  to  the  excretion  of  so  much 
more  carbon  than  they  were  intended  to  provide 
for ;  hence  the  blood  becomes  more  venous,  more 
liable  to  form  congestions,  and  to  dilate  the  yield- 
ing walls  of  the  heart,  by  its  retarded  pace.  The 
effect  of  diminished  circulation,  in  also  producing 
degeneration  of  other  parts,  need  not  be  enlarged 
upon. 

The  Causes  of  Dyspepsia  may  be  briefly 
stated  as  follows :  — 

Excessive  mental  work  and  worry ; 

Inaction  of  the  body,  with  over-action  of  the 
mind; 

Eating  too  much  when  either  mind  or  body  is 
exhausted  ; 

Under-feeding,  that  is,  not  taking  a  sufficient 


30  DYSPEPSIA. 

quantity  of  nutritious  food,  or  not  eating  a  suffi- 
cient variety ; 

The  habitual  abuse  of  alcohol,  opium,  tea,  to- 
bacco, purgative  medicines,  "  bitters,"  etc. 

Another  cause  that  should  be  mentioned  is  a 
diseased  state  of  the  lungs  or  heart.  It  must  not 
be  forgotten,  however,  that  while  diseases  of  the 
lungs  and  heart  are  not  unfrequently  among  the 
causes  of  dyspepsia,  these  diseases  are  in  many 
cases  the  direct  result  of  dyspepsia,  or  of  the  in- 
nutrition caused  by  it. 

I  wish  once  more  to  repeat,  there  is  no  case  of 
dyspepsia,  unless  it  be  accompanied  by  some  nec- 
essarily fatal  disease,  but  what  can  be  perfectly 
and  perma7iently  cured,  by  careful  and  judicious 
treatment. 

To  attain  this  end,  the  form  of  dyspepsia  in 
each  case  must  be  made  out,  the  proper  remedies 
applied,  and  thus  this  disease,  which  is  the  most 
common,  and  which  causes  more  suffering,  both 
mentally  and  bodily,  than  any  other  one,  become 
a  comparative  rarity. 


COLUMBIA  UNIVERSITY 

This  bqgk  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

C2ei638)MS0 

RC826 


B67 


Bowen 

Threne 


